Health coverage starts for many under new law

WASHINGTON - Millions of Americans will begin receiving health insurance coverage under the Affordable Care Act on Wednesday after a rollout hobbled by delays and technical problems.

The decisive new moment in the effort to overhaul the country's health care system will test the law's central premise - that extending coverage to far more Americans will improve the nation's health and help many avoid crippling medical bills.

Starting Wednesday, health insurance companies can no longer deny coverage to people with pre-existing conditions and cannot charge higher premiums to women than to men for the same coverage. In most cases, insurers must provide a standard set of benefits prescribed by federal law and regulations. And they cannot set dollar limits on what they spend on "essential health benefits" for a policyholder.

Important milestone

"I feel a huge sense of relief," said Katie Norvell, a 33-year-old music therapist in St. Louis, who has been uninsured for 3½ years and has a pre-existing gynecological condition, endometriosis. She signed up Dec. 22 for a midlevel silver plan offered by Coventry Health Care, now owned by Aetna, and has already begun making doctor's appointments.

Although this is an important milestone for the law, it is unlikely to end the constant partisan battles that began even before its passage nearly four years ago. And doctors, hospitals and pharmacists say consumers could initially experience some delays and difficulties as they try to use their new insurance.

A series of last-minute changes in rules and deadlines for people to sign up and pay premiums has left less time for insurers to activate coverage and issue identification cards, adding to the uncertainty caused by the troubled rollout of the health exchange.

Still problems

"There will be a lot of confusion," said Brian Caswell, a former president of the Kansas Pharmacists Association, who owns a drugstore in rural Baxter Springs, Kan. "Many people will get insurance cards but will not have a clue what's covered, what's not covered and what they are supposed to pay."

Others may find that their insurance company has no record of their enrollment, because the information was not sent by the online marketplace where they signed up for coverage. Even if they are properly enrolled, some of the newly insured may have trouble finding doctors who accept their health plans, many of which are restricting the number of providers in their networks to hold down premium costs.

And as newly insured consumers sort through details of their coverage, others will find that they are no longer insured by their old plans, which were canceled or discontinued because they did not comply with minimum coverage requirements of the law. Of several million who received cancellation notices, most should be able to obtain other coverage, the Obama administration says.

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Kathleen Sebelius, the secretary of health and human services, said Tuesday that more than 2.1 million people had selected private health plans, about half of them through the federal insurance exchange and half in marketplaces run by states. In addition, hundreds of thousands of Americans have enrolled in Medicaid, the government health insurance program for low-income people, which about half the states have decided to expand under the law.

Federal officials said they did not know how many subscribers were replacing policies canceled because they did not meet coverage standards.

Coverage starts today

Subscribers will be entitled to coverage starting Wednesday if they pay the first month's premium by the due date, which is Jan. 10 for many insurers.

Ana Yngelmo, a 37-year-old immigration lawyer in Kearny, N.J., said she would use her new insurance to start seeing a primary care doctor and to get her first mammogram. Yngelmo, who said she had been uninsured for 16 months, chose a platinum plan with generous coverage - "the best they had," she said - and no deductible. She qualified for a tax-credit subsidy that will lower her monthly premium to $350 - still expensive, she said.